EMT - 1 Expanded Scope Flashcards
Please note, this is not the basic scope of practice that is applied in every state. It is described in the syllabus, this goes into the EXPANDED scope of practice.
What is an expanded scope of practice? What does this mean for us?
- Expanded scope of practice simply states that there are additional activities that an EMT may perform in a prehospital setting and/or during interfacilitiy transport unique to a specific county.
- So essentially this is after title 22 and even more specific to a county; a section of california instead of the state.
When was this expanded scope of practice implemented and revised in LA county? Under what policy is it? After what date were all EMT-1’s certified or recertified in LA County required to attend EMT-1 expanded scope training?
- Implemented 2/28/97; policy #802
- Revised 2/1/11
- 5/30/97; after this date all EMT-1’s in LA county were required to attended expanded scope training.
If finer points of this policy are difficult to remember, use cheat cards!
Under Title 22, what two drugs are we allowed to adminster?
- We are only allowed to adminster glucose and oxygen
Are we allowed to monitor IV’s? What kind? What are we allowed to do with IV’s?
What if there is infiltration?
- Yes
- We can only monitor IV’s with no additives so we can monitor glucose solutions, isotonic balanced salt solutions, or lactated ringers.
We are allowed to…
- Monitor, maintain, adjust, or preset the rate of flow
Infiltration
- We are allowed to shut off the IV if there are signs of infiltration but not adjust or remove it!
What medications may EMT-1’s be allowed to assist or allow the patient to self administer? What is also allowed (as far as meds go) in a 2011 revision of the scope of practice? So, if any assistance is given, what we do?
The medications we can assist or allow self-administration are…
- Siblingual nitroglycerin tablets or lingual aerosol (nitrolingual)
- Bronchodilator inhalers or nebulizers
- Epinephrine hydrochloride devices (EpiPen Auto-injector)
Under revision
- Assist with any emergency medication such as if the patient is experiencing chest pain and the doctor said that he patient can use aspirin, you can help the patient with that.
If we gave a medication we should make sure…
- An ALS unit is enroute
- Or, patient is transported immediately to the most accessible medical facility per policy Ref. 502.
- NEVER to treat & release a patient - this is emergency supportive therapy.
What are the five parameters (guidelines) we should follow under adminstration of medications?
- Note if medications fall under the 3 medications you can help with!
- Nitroglycerin
- Epinephrine
- Bronchodilator
- Patient’s condition (signs and symptoms) must indicate use (specifically & conclusively)
- Must be prescribed to patient
- Must be patient’s own medication
- Note doses PTA (prior to arrival) count
Are you allowed to carry these medications on the unit or your jump kit?
- NO!!! You are never allowed to carry these medications on unit or in your jump kit!
- If you are told otherwise, it is wrong!
What are all the drug routes?
- IV - intravenous (injected into vein)
- SL - Sublingual (placed under tongue; absorbed)
- PO - By mouth
- IM - Intramuscular (injected into muscles)
- SQ/SC - Subcutaneous (injected in tissues between skin and muscles)
- IO - Interosseous (into bone marrow)
- Transcutaneous (absorbed into the skin, such as NTG)
- IN - inhaled
- PR - Per rectum
Sure, you know the DICCE for IV therapy, how about the DICCE for medications?
- D - Dose (changed from Drug w/ IV)
- I - Integrity
- C - Concentration (changed from Color w/ IV)
- C - Clarity
- E - Expiration date
Answer the following questions regarding NITROGLYCERIN (NTG)…
- What is the indication for use of nitroglycerin?
- What is the route of usage?
- How much dosage should be repeated?
- What are the contraindications for use?
Notes…
- What forms can it come in?
- What should you do after adminstration?
NITROGLYCERIN…
- Indication
- Chest pain
- Route
- Sublingual
- Repeat
- Max of 3 doses
- Contraindication (don’t forget to document!)
- BP less than 100 systolic
- Any sexually enhancing drugs w/in 24 hours (e.g. viagra)
- 3 doses PTA (prior to arrival)
- Head injury
NOTES…
- It comes in a tablet, spray, or skin patch form.
- Always check blood pressure after adminstration as it is a VASODIALTOR!
Answer the following questions regarding EPINEPHRINE!
- What is the indication for use of the epinephrine autoinjector?
- How many times do you repeat dosage?
- What is the route of it?
- Where do you administer it?
Notes regarding epinephrine…
- Regrading brands?
- How much of a dose should you usually give?
- What would happen if you injected it in the buttocks, arm, hands?
- What would happen if you IV administered it?
- What are the side effects of this drug?
- Indication
- Severe allergic reaction
- Repeat
- As prescribed; for ten seconds
- Route
- IM; intramuscular
- Site
- Upper-outer thigh only!
Notes…
- There are several brands
- Do 1 dose only
- Injection into buttocks, arms, hands, will result in inadequate absorption and soft tissue damage.
- IV administration could cause MI or CVA
- Side effects include
- Tachycardia
- Pallor
- Dizziness
- Chest pain
- Headache
- N/V
Answer the following questions regarding bronchodilator inhalers?
- What are the indications for use?
- How often should you repeat the dosage?
- What are the contraindications?
Notes…
- What should you do if you are trying to use this in a cold environment?
- How should they be breathing during adminstration?
What are some commonly prescribed bronchodilators?
- Indications
- Dyspnea, associated with bronchospasm (asthma, bronchitis, COPD)
- Repeat
- As perscribed
- Contraindications
- Patient is unable to use device
- Maximum doses taken PTA
Notes…
- In a cold environment, roll inhaler between your palms
- Have them inhale it slowly and continuously
Commonly prescribed bronchodialators…
- Albuterol, terbutaline, and metaproterenol
- Proventil, ventolin, bronkosol, bronkometer, alupent, meteprel, brethine, etc… they all have the same package.
What are some forms/devices of inhalers? What if EMT is unfamilar with this equipment?
- Inhaler
- Inhaler w/ spacer (attachment on inhaler used for children and elderly)
- Hand-held nebulizer (usually connected with oxygen)
- Pulmonaid device
If EMT is unfamilar…
- Patient or caretaker should set it up.
So you do an assessment and then document what regarding medicine?
- Document medicine prescribed by MD
- Document if medicine is patient’s
- Other factors such as route, site of dose used
- Vitals and reassessment after this treatment
According to the expanded scope of practice for LA, what can we do regarding IV monitoring with additives?
We can monitor, maintain, adjust a TKO rate of flow the following IVs with additives…
- Folic acid (vitamin B9) with a maximum of 1mg per 1000mL of IV solution max.
- Mutivitamins with 1 vial added to 1000mL of IV solution max.
- Magnesium Sulfate (MgSO4) with a maximum of 1 vial per 1000mL of IV solution max in conjunction w/ Multivitamins (MVI)
- Thiamine (vitamin B1) with a maxium of 100mg added to 1000mL of IV solution.
